Business Financing Request

1. Tell Us About Your Business

Business Legal Name*

DBA (if applicable)

Business Website*

Primary Contact Name*

Title*

Business Email*

Business Phone*

Business City*

State*
Select StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Year Business Established*
Select Year20262025202420232022202120202015-20192010-20142005-2009Before 2005

Approximate Annual Revenue*
Select RangeUnder $500K$500K - $1M$1M - $5M$5M - $10M$10M - $25M$25M - $50M$50M+

Industry / What Does Your Company Do?*

2. What Are You Financing?

Financing Type (select all that apply)*
Project FinancingPurchase Order / Contract FinancingEquipment FinancingAsset-Based Line of CreditAcquisition FinancingCommercial Real EstateWorking CapitalOther

Amount of Financing Requested*
Select RangeUnder $250K$250K - $500K$500K - $1M$1M - $5M$5M - $10M$10M+

When Is the Capital Needed?*
Select TimeframeImmediatelyWithin 30 days1-3 months3-6 months6+ months / Planning ahead

Primary Use of Funds* (up to 250 characters)

3. Tell Us About the Transaction

What Supports the Financing Request? (select all that apply)*
Purchase OrderExecuted Customer ContractAccounts ReceivableEquipment / MachineryInventoryRecurring Customer RevenueProject BacklogBusiness Cash FlowOther Business Assets

Equipment Details

4. Anything Else We Should Know?

Additional Information (optional, up to 500 characters)

5. How Did You Hear About Us?

Referral Source*
Select an OptionGoogle SearchReferralSocial MediaEmailIndustry EventExisting ClientGreysun CentrifugeOther

Referral Contact / Company

Referral Contact Email

Referral Contact Phone

6. Current Financing

Does the company currently have business debt?
YesNoNot Sure

Approximate Total Business Debt
Select RangeNoneUnder $100K$100K - $500K$500K - $1M$1M+

Current Bank / Primary Lender (optional)

Does the business currently have any daily or weekly repayment financing?
YesNoNot Sure

By submitting this request, you authorize Everstream Capital to contact you regarding the financing opportunity described above. Submission does not constitute a loan application, financing approval or commitment to lend.